A 38-year-old nulliparous woman with grade 1 endometrial carcinoma limited to the endometrium (FIGO Stage IA) desires fertility preservation. Which treatment is appropriate?
- A Progestin therapy (medroxyprogesterone acetate or levonorgestrel IUS) with surveillance hysteroscopy every 3–6 months ✓
- B Total hysterectomy with bilateral salpingo-oophorectomy
- C GnRH agonist alone for 6 months
- D Pelvic radiation therapy
Correct answer: A. Progestin therapy (medroxyprogesterone acetate or levonorgestrel IUS) with surveillance hysteroscopy every 3–6 months
Explanation
Fertility-sparing management of Grade 1 endometrioid carcinoma limited to the endometrium (Stage IA) in women who strongly desire to preserve fertility involves progestin therapy — either high-dose oral MPA (medroxyprogesterone acetate 200–600 mg/day) or levonorgestrel IUS — with surveillance hysteroscopy and endometrial biopsy every 3–6 months to assess response. Complete response rates of 60–80% are reported. After completing childbearing, hysterectomy is recommended. This is considered investigational but is guideline-supported in selected patients.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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